Individual provider · Type 1 NPI

Matthew Ray Bennett, PA-C

Surgical Physician Assistant · Waconia, MN

NPI number 1376955971 Active

Practice location

560 S Maple St, Suite 200
Waconia, MN 55387-1733

Call (952) 442-2163 Map

Fax (952) 442-5903

Mailing address

4200 Dahlberg Dr, Suite 300
Golden Valley, MN 55422-4840

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X2193 (MN)

Surgical Physician Assistant: Definition to come...

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About NPI 1376955971

Matthew Ray Bennett, PA-C's National Provider Identifier is 1376955971, issued on May 30, 2014. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Waconia, MN. The record was last updated on Jan 9, 2015.